Premature Ventricular Contractions In Patients Research Articles

Propensity-score matched comparison of renal and neurohormonal effects of catheter ablation for frequent premature ventricular contractions in patients with and without systolic dysfunction.

Catheter ablation (CA) for premature ventricular contractions (PVCs) restores cardiac and renal functions in patients with reduced left ventricular ejection fraction (LVEF); however, its effects on preserved EF remain unelucidated. The study cohort comprised 246 patients with a PVC burden of >10% on Holter electrocardiography. Using propensity matching, we compared the changes in B-type natriuretic peptide (BNP) levels and estimated glomerular filtration rate (eGFR) in patients who underwent CA or did not. Postoperative BNP levels were decreased significantly in the CA group, regardless of the degree of LVEF, whereas there was no change in those of the non-CA group. Among patients who underwent CA, BNP levels decreased from 44.1 to 33.0 pg/mL in those with LVEF ≥50% (p = .002) and from 141.0 to 87.9 pg/mL in those with LVEF <50% (p < .001). Regarding eGFR, postoperative eGFR was significantly improved in the CA group of patients with LVEF ≥50% (from 71.4 to 74.7 mL/min/1.73 m2, p = .006), whereas it decreased in the non-CA group. A similar trend was observed in the group with a reduced LVEF. Adjusted for propensity score matching, there was a significant decrease in the BNP level and recovery of eGFR after CA in patients with LVEF >50%. This study showed that CA for frequent PVCs decreases BNP levels and increases eGFR even in patients with preserved LVEF.

Electrophysiological Characteristics and Ablation Outcomes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia.

Catheter ablation of premature ventricular contractions (PVCs) that trigger polymorphic ventricular tachycardia (PVT) or ventricular fibrillation has been reported as a novel therapy to reduce the syncope events in patients with catecholaminergic PVT, whereas the long-term ablation outcome and its value in improving exercise-induced ventricular arrhythmias remain unclear. Fourteen consecutive selected patients with catecholaminergic PVT (mean±SD age, 16±6 years; 43% male patients) treated with maximum β-blockers with no possibility of adding flecainide were prospectively enrolled for catheter ablation. The primary end point was syncope recurrence, and the secondary end point was the reduction of the ventricular arrhythmia score during exercise testing. Twenty-six PVT/ventricular fibrillation-triggering PVCs were identified for ablation. The trigger beats arose from the left ventricle in 50% of the cases and from both ventricles in 36% of the cases. Purkinje potentials were observed at 27% of the targets. After a mean follow-up of 49 months after ablation, 8 (57%) patients were free from syncope recurrence. Ablation of trigger beat significantly reduced the syncope frequency (mean±SD, 4.3±1.6 to 0.5±0.8 events per year; P<0.001) and improved the ventricular arrhythmia scores at the 3-month (5 [range, 3-6] to 1.5 [range, 0-5]; P=0.002) and 12-month (5 [range, 3-6] to 2 [range, 0-5]; P=0.014) follow-ups. The induction of nontriggering PVCs postablation was closely associated with syncope recurrence (hazard ratio, 6.8 [95% CI, 1.3-35.5]; P=0.026). Catheter ablation of PVT/ventricular fibrillation-triggering PVCs in patients with catecholaminergic PVT who cannot receive flecainide treatment seems to be a safe and feasible adjunctive treatment that may reduce the syncope burden and improve exercise-related ventricular arrhythmias. Induction of nontriggering PVCs after ablation is associated with a higher risk of syncope recurrence.

Abstract 15352: Deep Learning Model-Enabled Electrocardiogram to Localize Premature Ventricular Contractions in Patients Referred for Catheter Ablation

Introduction: Accurate pre-procedure localization of the premature ventricular contractions (PVCs) is critical in preparing for the ablation. So far, no tools exist for artificial intelligence guided PVC-localization. Hypothesis: Trained deep learning model will be able to predict the site of origin (SOO) of PVCs using 12 lead electrocardiogram (ECG). Methods: We analyzed 707 ECG-ablation pairs from 2403 patients who had at least one ECG flagged for PVCs in the 6 months prior to their procedure. First, we used a cohort of 100,000 ECGs without PVCs and 10,000 ECGs with PVCs to train a convolutional neural network (CNN) to isolate the ECG segments with PVCs in them from a 12-lead ECG (Figure 1). We then trained two models, one utilizing a 10-second 12-lead ECG, and the other with just the isolated PVC beats as input. The models were trained using the Keras framework with TensorFlow (Google). Results: The mean age of the patients in the cohort was 61.2 ± 15.0 years. 66.3 percent of patients underwent left ventricle ablation, 54.6 percent had outflow ablation, and 55.3 percent had ablation of sites with leftward axis (septal location for midline and left ventricle PVCs). The model trained on 10-second ECGs yielded validation and test AUCs of 0.941 and 0.931 for outflow, 0.898 and 0.891 for ventricle, and 0.863 and 0.846 for leftward axis (Figure 1A). The model trained on isolated segments containing PVC beats yielded validation and test AUCs of 0.966 and 0.957 for outflow, 0.879 and 0.907 for ventricle, and 0.846 and 0.829 for SOO for leftward axis (Figure 1B). Conclusions: We have trained an accurate convolutional neural network that can predict SOO using the surface ECG. Further fine-tuning would be needed to refine the model and develop prediction of specific sites.

Focus on malignant ventricular premature contractions

Premature ventricular contractions (PVCs) are common. Although often benign, they can also be associated with increased morbidity and mortality. The aim of this review was to assess the risk evaluation of PVCs in patients with or without structural heart disease and discuss the management of this arrhythmia.Reports published in English were searched in PubMed with the following search terms: premature ventricular contraction, ectopic ventricular beat, ventricular extrasystole, antiarrhythmic drugs, ablation, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation and torsade de pointe.This analysis suggests that all patients with frequent PVCs should be assessed for PVC burden, symptom status and the presence of structural heart disease. PVCs in patients with structurally normal hearts was once considered a benign phenomenon. Uncommonly, PVCs may provoke life-threatening arrhythmias. Ventricular fibrillation is the initial mode of malignant rapid ventricular arrhythmias (MRVAs). Patients with malignant PVC and PVC burden >10% are at increased risk of MRVA in case of myocardial infarction and heart failure. MRVA is the primary cause of sudden cardiac death in patients with and without structural heart disease. Therapeutic options include medical therapy and catheter ablation, the latter more effective and potentially curable, particularly in patients with left ventricular dysfunction.The timely recognition and effective treatment of malignant PVCs in symptomatic patients with underling cardiomyopathy are mandatory to initiate early therapies before the occurrence of adverse clinical outcomes and to improve the long-term prognosis.

Incidence of premature ventricular contractions in patients with cardiovascular diseases risk factors

Abstract Funding Acknowledgements Type of funding sources: None. Aim of the study To establish the incidence of premature ventricular contractions among individuals with high and very high risk of cardiovascular diseases. Materials and methods During the period between 2007-2013 a total of 4,214 individuals were examined, age ranged from 35 to 85 years. Each individual underwent 24-hour Holter monitoring. All participants of the study were divided into groups: 1-st - patients with coronary artery disease (mainly stable angina), but without accompanying risk factors for cardiovascular diseases, such as smoking and obesity (n=234); 2nd group - people who smoked 5 or more cigarettes per day for more than 2 years (n=144); 3rd group - obese people without concomitant coronary artery disease and arterial hypertension (n=197); 4th group - people with obesity and hypertension (n=187). The control group included 149 practically healthy people. The groups were statistically homogenic in age and gender. The incidence of premature ventricular contractions in was following according to V. Lown and M. Wolf classification: the 1st group – I - 16 (6,83%), II - 23 (9,82%), III - 2 (0,85%), IV - 13 (5,55%), V - 18 (7,69%); the 2nd group - 14 (9,72%), II – 10 (6,95%), III - 5 (3,47%), IV - 28 (19,44%), V - 13 (9,02%); the 3rd - I - 1 (7,61%), II - 6 (3,04%), III - 3 (1,52%), IV - 21 (10,65%), V - 13 (6,6%), the 4th - I - 22 (11,76%), II - 13 (6,95%), III - 2 (1,07%), IV - 24 (12,83%), V - 8 (4,27%). The lowest incidence of this arrhythmia was observed among patients with stable angina - 30,34%. This can be explained by patients being more thoroughly supervised by doctors and higher compliance for treatment. Another reason was that groups 2-4 included people with only risk factors, and group 1 - people with the coronary artery disease. Among obese people with and without hypertension, the incidence of this arrhythmia was almost the same – 35,1% and 36,7%, respectively, and was not significantly different from control group (33,6%). Therefore, analyzing the data presented above, we established that people who smoke tobacco have higher incidence of ventricular premature contractions than in healthy individuals and people with obesity and hypertension. There was observed no statistically significant difference in the incidence of ventricular premature contractions in individuals with isolated obesity or obesity concomitant with arterial hypertension.

Asymptomatische ventrikuläre Extrasystolen behandeln?

Premature ventricular contractions (PVC) are acommon arrhythmia. Therapy is indicated in case of frequent symptomatic PVC or deterioration of left ventricular function. Asymptomatic patients should be evaluated critically for possible PVC-associated symptoms. Catheter ablation of PVCs in patients with normal left ventricular ejection fraction (LVEF) is safe and effective. PVC-induced cardiomyopathy should be considered in unexplained LVEF dysfunction with aPVC burden of at least 10%. If ECG and echocardiography do not clearly rule out structural heart disease (SHD) or the clinical presentation raises suspicion of SHD, cardiac magnetic resonance imaging should be performed. If SHD has been excluded, the guidelines recommend catheter ablation as primary therapy in frequent monomorphic PVC, regardless of symptoms. To prevent PVC-induced cardiomyopathy, ablation can also be considered in asymptomatic patients with aPVC burden > 20%. Also, in patients with known SHD frequent PVC can aggravate LV dysfunction and catheter ablation should be considered.

Abstract 15433: Very Late Recurrence After Successful Ablation of Premature Ventricular Contractions in Patients Without Structural Heart Disease

Background: Earlier studies have shown the superiority of catheter ablation over pharmacological therapy in eliminating premature ventricular contractions (PVC) in patients without structural heart disease. We investigated very late recurrences after successful PVC ablation in this cohort. Methods: Consecutive patients undergoing clinically indicated radiofrequency ablation for symptomatic idiopathic PVCs, documented by standard ECG, were included in the analysis and prospectively followed up. Those with history of structural heart disease were excluded. For all patients, 12-lead ECGs were reviewed to assess PVC morphology. During the index procedure, all PVC morphologies were targeted for ablation. Standardized RF power settings (40-50 W) were used during the procedure. Ablation was performed using 4-mm irrigated tip catheter guided by 3-D mapping system and intra-cardiac echocardiography. Patients were followed up with remote monitoring as well as ICD interrogations and office visits every 6 months for 4 years. Long-term success was defined as absence of previously targeted PVCs or any new PVC morphology on 12-lead ECG or device interrogation during all follow-up visits. Results: In total, 638 patients were included (mean age 59.2±5.6 years, 69.75% male, LVEF 54±12%). At the index ablation, PVCs were detected to be localized in the right ventricular outflow tract in 268 (42%), left ventricular outflow tract in 299 (46.8%) and multiple sites of origin in 71 (11.2%) patients. Non-inducibility was achieved in all patients at the end of the index procedure. At 4 years, 585 (91.7%) patients remained arrhythmia-free. Remaining 53 patients (8.1%) experiencing recurrence underwent repeat procedure. Median time to recurrence was 29±6.2 months. At the redo, new PVC morphologies were detected and ablated in 46/53 (86.8%) patients. One year after the repeat ablation, 50/53 (94.3%) were arrhythmia-free. Conclusion: In this prospective single-center series, very late recurrence following index PVC ablation in patients with no structural heart disease was mostly associated with new PVC morphologies that were amenable to be successfully ablated at the repeat procedure.

Prognostic implication of premature ventricular contractions in patients without structural heart disease.

Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavourable prognosis in patients with structural heart disease. However, the prognostic significance in absence of heart disease is debated. With this study, we aim to investigate whether subjects with PVC, without structural heart disease, have a worse prognosis than the general population. Patients evaluated for PVC at a secondary care centre in Stockholm County from January 2010 to December 2016 were identified. We included patients without history of previous heart disease who had undergone echocardiography and exercise test with normal findings. Based on sex and age, we matched the PVC cohort to a four times bigger control group from the general population and compared the outcome in terms of mortality and cardiovascular morbidity during a median follow-up time of 5.2 years. We included 820 patients and 3,264 controls. Based on a non-inferiority analysis, the PVC group did not have a higher mortality than the control group (0.44, CI 0.27-0.72). Sensitivity analysis with propensity score matching confirmed this result. PVC patients, who after thorough evaluation showed no signs of structural heart disease, did not have a worse prognosis when compared to an age- and sex- control group based on the general population.

The Tp-e/QT ratio as a predictor of nocturnal premature ventricular contraction events in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is significantly associated with a higher risk of ventricular arrhythmia (VA). QT, the Tp-e/QT ratio, and QT dispersion (QTd) are used to evaluate myocardial repolarization and are highly correlated with VA. The aim was to evaluate the predictive value of the Tp-e/QT ratio and other electrocardiogram (ECG) parameters for nocturnal premature ventricular contractions (PVCs) in patients withOSA. We retrospectively analyzed data from patients withOSA and conducted a 1:1 matched cohort study. Patients diagnosed with OSA whomet our criteria for the PVC group, and sex- and age-matched patients withOSA who met our criteria for the control groupwere enrolled in the study. The Tp-e, Tp-e/QT ratio, corrected QT interval (QTc), corrected Tp-e interval (Tp-ec), and QTd were measured, calculated and analyzed. Patients in the PVC group(n = 31) showed a greater Tp-e, Tp-ec, QTc, Tp-e/QT ratio, and QTd than patients in the control group(n = 31). In the univariate binary logistic regression analysis, higher Tp-ec (OR: 1.025; P = 0.042), QTc (OR: 1.014; P = 0.036), Tp-e/QT ratio (OR: 1.675; P < 0.001), and QTd (OR: 1.052; P = 0.012) values were all significantly associated with nocturnal PVCs. In multivariate analysis and receiver operating characteristic analysis, a higher Tp-e/QT ratio (OR: 2.168; 95% CI: 0.762-0.952; P < 0.001) was an independent predictor of nocturnal PVCs. The QTc, Tp-e/QT ratio, and QTd in patients withOSA with nocturnal PVCs were significantly increased compared with those in patients without nocturnal PVCs. A prolonged Tp-e/QT ratio was an independent predictor of nocturnal PVCs in patients with OSA.

Assessment of functional and structural echocardiography parameters in patients with frequent premature ventricular contractions without structural heart disease.

Premature ventricular contractions (PVCs) are early depolarizations of the myocardium which originate from the ventricle. PVCs have previously been considered a benign condition. The clinical significance of PVCs in patients without structural heart disease is controversial. In this cross-sectional study, patients with a palpitation complaint who underwent electrocardiography (ECG) Holter recording for 48 hours were analyzed. Patients with frequent PVCs (more than ten times in 1 hour) were identified and enrolled in the study. 26 patients were in the PVC group, and 26 patients were in the control group without PVC. The identified patients underwent an echocardiographic examination with strain modality. There were 15 women (57.7%) in the PVC group and 17 women (65.4%) in the control group (P = 0.57). Two patients in the PVC group and three patients in the control group were hypertensive (P > 0.99). There was only one patient with diabetes in PVC and control group (P > 0.99). There were two smokers in the PVC group, whereas there was no smoker in the control group (P = 0.49). In comparison between two groups, patients with frequent PVCs had significantly larger left ventricular end-diastolic volume index (LVEDVI) (P = 0.048) along with lower left ventricular ejection fraction (LVEF) (P = 0.011), lower (more positive) left ventricular global longitudinal strain (LVGLS) (P = 0.001), and lower peak systolic mitral annular velocity (S') (P = 0.045). The left atrial volume index (LAVI) was significantly larger in the PVC group (P = 0.001). In speckle tracking echocardiography (STE) parameters, global peak atrial longitudinal strain (PALS) (P = 0.001) and peak atrial contraction strain (PACS) (P = 0.001) were significantly lower and time to peak longitudinal strain (TPLS) (P = 0.002) was significantly higher in the PVC group. In this study, left atrial (LA) and left ventricular (LV) function and geometry were adversely affected by frequent PVCs. Early diagnosis of these effects is possible with echocardiography along with strain analysis. It can guide the timely treatment of PVC to avoid the harmful effects of frequent PVCs on the heart.

Radiofrequency ablation in Brugada syndrome.

Radiofrequency ablation in Brugada syndrome.

Myocardial extracellular space expansion is related to burden of premature ventricular contractions in patients with hypertrophic cardiomyopathy without non-sustained ventricular tachycardia

Abstract Funding Acknowledgements Type of funding sources: None. Background Current guidelines suggest the presence of non-sustained ventricular tachycardia (NSVT) as a risk factor of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, high burden of premature ventricular contraction (PVC) may reflect myocardial fibrosis although the absence of NSVT. Purpose We investigated the association between PVC burden and myocardial extracellular space expansion in HCM patients without NSVT. Methods Of the 212 patients prospectively enrolled to the HCM registry of genetics, 84 patients were evaluated with both cardiac magnetic resonance and 24hr holter. Among them, 71 patients (58 males, mean age: 71 ± 13 years) have not been diagnosed with NSVT. Results Patients with NSVT (n = 13) showed more impaired LA functional indices and higher myocardial fibrosis burden compared with patients without NSVT (n = 71). Among patients who have not been diagnosed with NSVT, patients with late gadolinium enhancement (LGE, n = 46) had a higher total beats (109 ± 332 vs. 7 ± 13 beats per a day, p = 0.003) and burden (0.114 ± 0.225 vs. 0.008 ± 0.014 %, p = 0.003) of PVC during 24-hour compared with patients without LGE (n = 25). %LGE was correlated with total beats of PVC (r = 0.358, p = 0.002) and PVC burden (r = 0.377, p = 0.001). ECV also correlated with total beats of PVC (r = 0.387, p = 0.001) and PVC burden (r = 0.401, p = 0.001). The optimal cutoff value for PVC number was 45 (37.0% of sensitivity and 100% of specificity) with 0.733 of the area under the ROC curve (p &amp;lt; 0.001). Pathogenic or likely pathogenic sarcomere mutation was higher in NSVT group than no NSVT group (p &amp;lt; 0.05), and had a higher tendency in higher PVC burden group (0.05 &amp;lt; p &amp;lt; 0.1) than lower PVC burden group. Conclusions Total beats and burden of PVC are significantly related to increase in myocardial fibrosis in HCM patients without NSVT. Abstract Figure. Mechanism of ventricular arrhythmia

Premature ventricular contractions in patients with arterial hypertension and obstructive sleep apnea

Premature ventricular contractions in patients with arterial hypertension and obstructive sleep apnea

Significance of Exercise-Related Ventricular Arrhythmias in Patients With Brugada Syndrome.

BackgroundSinus tachycardia during exercise attenuates ST‐segment elevation in patients with Brugada syndrome, whereas ST‐segment augmentation after an exercise test is a high‐risk sign. Some patients have premature ventricular contractions (PVCs) related to exercise, but the significance of exercise‐related PVCs in patients with Brugada syndrome is still unknown. The objective of this study was to determine the significance of exercise‐related PVCs for predicting occurrence of ventricular fibrillation (VF) in patients with Brugada syndrome.Methods and ResultsThe subjects were 307 patients with Brugada syndrome who performed a treadmill exercise test. We evaluated the occurrence of PVCs at rest, during exercise and at the peak of exercise, and during recovery after exercise (0–5 minutes). We followed the patients for 92±68 months and evaluated the occurrence of VF. PVCs occurred in 82 patients (27%) at the time of treadmill exercise test: PVCs appeared at rest in 14 patients (4%), during exercise in 60 patients (20%), immediately after exercise (0–1.5 minutes) in 28 patients (9%), early after exercise (1.5–3 minutes) in 18 patients (6%), and late after exercise (3–5 minutes) in 12 patients (4%). Thirty patients experienced VF during follow‐up. Multivariable analysis including symptoms, spontaneous type 1 ECG, and PVCs in the early recovery phase showed that these factors were independently associated with VF events during follow‐up.ConclusionsPVCs early after an exercise test are associated with future occurrence of VF events. Rebound of vagal nerve activity at the early recovery phase would promote ST‐segment augmentation and PVCs in high‐risk patients with Brugada syndrome.

Substrate guided ablation of idiopathic right ventricular outflow tract premature ventricular contractions in patients with low arrhythmia burden during the procedure

Abstract Background Ablation of premature ventricular contractions (PVCs) is currently based on activation mapping. This strategy is impaired by the absence or paucity of PVCs on the day of the procedure. Frequently, isolated diastolic potentials (DP) are present at the successful ablation site in sinus rhythm (SR), although their meaning is still a matter of debate. Objective Evaluate the feasibility and results of a substrate-based approach for ablation of idiopathic right ventricular outflow tract (RVOT) PVCs, in patients that present with a low PVC burden during the procedure. Methods We included 12 consecutive patients referred for ablation of frequent (&amp;gt;10000/24 hours) idiopathic PVCs from the RVOT that present with less than 2 PVCs/min in the beginning of the procedure. The ablation was based on fast mapping of the RVOT in SR looking for DPs, defined as isolated small amplitude potentials occurring after the T wave of the surface ECG in SR (Figure). The area with DPs was marked and a reduced activation mapping of the PVCs was done in that area. We evaluated the procedure time, mapping, fluoroscopy and radiofrequency (RF) application times. The number of points used for the maps, the area of DPs, local activation time and success rate. Values are presented as median (Q1-Q3). Electroanatomical mapping of the RVOT in SR was also performed in a control group of 10 subjects that underwent ablation of supraventricular arrhythmias, to evaluate the prevalence of DPs in subjects without PVCs. Results The number of PVCs during the procedure was 1 (0.1–1.6)/min. Both groups did not differ in relation to age or gender. Median age 45 (34–65) years, 6 males in the PVC group and 40 (33–65) years, 6 males in the control group, p=0.821 and p=0.231 respectively. The number of points sampled per RVOT map in SR was 400 (193–500) in the PVC group and 330 (277–425) in the control group, p=0.539. All patients in the study group had DPs in the RVOT. None of the control group subjects had DPs in the RVOT. Ablation data is presented in the Table. The acute success rate was 100%. After a median follow-up time of 4 (3–6) months one patient had recurrence. Conclusion In these group of patients with very low PVC burden during the procedure, this approach partially based on substrate mapping, made ablation of the PVCs feasible, in a fast and efficient way. Funding Acknowledgement Type of funding source: None

Betel-Quid Chewing, Heart Failure, and Premature Ventricular Contractions in Patients with Cardiopulmonary Symptoms.

Betel-quid (BQ) is a commonly used psychoactive substance that renders a specific cardiotoxicity. The purpose of this study was to investigate the association between BQ chewing and premature ventricular contractions (PVC) in patients with cardiopulmonary symptoms, and examine the potential influences of cardiovascular and chronic diseases on such relationship. Participants were 146 patients with cardiopulmonary symptoms who participated in 24-h Holter electrocardiogram monitoring during 2012–2018 in a hospital serving residents that lived in a BQ high prevalence area. Data on substance uses and medical histories for cardiovascular and chronic diseases were collected. Baron–Kenny method was employed to evaluate possible mediation. In patients with cardiopulmonary symptoms, 36.3% were BQ users and 63.7% were nonusers. Adjusting for covariates, BQ chewing was significantly associated with heart failure and diabetes mellitus (adjusted odds ratio (aOR) = 3.4 and 2.3, respectively), but only heart failure was significantly correlated with a low and high level of PVC. Additionally controlling for the effect of heart failure, the risk of high PVC for BQ users reduced from 3.60 to 2.88; however, the risk for BQ chewers remained significant (95% CI: 1.06–7.84). Heart failure was found to explain 27.7% of the excessive effect of BQ use on high PVC. In conclusion, BQ use is directly associated with an elevated risk of high PVC in patients with cardiopulmonary symptoms. The higher risk might be elevated among patients who suffered heart failure. Given several research limitations, the findings from this study offer future opportunities for validation.

The method for prediction of high-grade premature ventricular contractions in patients with heart failure and preserved ejection fraction

Aim To develop a method for prediction of high-grade ventricular extrasystole (VE) in patients with chronic heart failure with preserved ejection fraction (CHF-PEF) based on results of an echocardiography (EchoCG) study.Material and methods At the first step, the study included 121 patients of the Cardiology Department, Municipal Clinical Hospital #31, St. Petersburg (calculation group) with symptoms and clinical signs of CHF-PEF (median age, 62 years). For testing accuracy of the developed formula, a control group was formed, which consisted of 42 patients with CHF-PEF (median age, 59 years). EchoCG at rest and ECG Holter monitoring were performed for all patient. The VE classification according to B. Lown and M. Wolf (1971) in the M. Ryan (1975) modification was used. Results of the evaluation were determined by the most significant recorded grade. Grade III or higher VE were considered as high-grade VE.Results Using logistic regression analysis of data for patients of the calculation group, a statistical model was constructed and a respective formula was developed to predict a probability of high-grade VE in CHF-PEF patients depending on the presence of risk factors (EchoCG criteria). According to the obtained data the following factors primarily contributed to the model: interventricular septal (IVS) thickness (p=0.007; Wald=7.44), end-diastolic volume index (EDVI) (p=0.044; Wald=4.13), and the degree of diastolic dysfunction (DD) (p&lt;0.0001; Wald=19.90). For testing the formula accuracy, the analysis was performed in the control group. Based on data of both stages, the following values were obtained: for the calculation group, the method sensitivity was 77.8 %, the specificity was 82.4 %, the accuracy was 81.0 %; for the control group, 81.8 %, 70 %, and 76.2 %, respectively; for both groups together, 79.3 %, 80.0 %, and 79.8 %, respectively. In ROC-analysis of this prognostic model, the area under the ROC-curve (AUC) was 0.852 (95 % CI: 0.776-0.910; p&lt;0.0001) for the calculation group; 0.818 (95 % CI: 0.669-0.920; p&lt;0.0001) for the control group; and 0.855 (95 % CI: 0.792-0.905; p&lt;0.0001) for both groups together, which indicated a good quality of the prognostic model.Conclusion The EchoCG predictors of high-grade VE in patients with CHF-PEF included degree of DD, EDVI, and IVS thickness. The developed method with the constructed formula for prediction of high-grade VE in CHF-PEF patients showed high sensitivity, specificity and accuracy.

Premature ventricular contractions in patients with an implantable cardioverter defibrillator cardiac resynchronization therapy device: Results from the UMBRELLA registry

BackgroundPremature ventricular contractions (PVC) are known to reduce the percentage of biventricular (BiV) pacing in patients with cardiac resynchronization (CRT), decreasing the clinical response. The aim of this study was to evaluate the prevalence of a high PVC burden, as well as therapeutic action (pharmacotherapy, catheter ablation or device programming), in a large CRT implantable-defibrillator (CRT-D) population. MethodsPatients with a CRT-D device from the UMBRELLA multicenter prospective remote monitoring registry were included. The PVC count was collected from each remote monitoring transmission. Patients were divided into two high (≥1 transmission ≥200/≥400 PVC/h, respectively) and one low (all transmissions <200 PVC/h) PVC count groups. The PVC burden following a high PVC count transmission was calculated. ResultsOf 1268 patients, 135 (11%) and 43 (3.4%) presented high PVC count (≥200/≥400 PVC/h, respectively). The majority of patients in the high PVC groups were not treated (61 [79%] and 32 [74%], respectively. Considering the untreated patients in the high PVC groups, median PVC/h was 199 (interquartile range [IQR]: 196) and 271 (IQR: 330), respectively. The PVC burden (proportion of time with PVC/h ≥ 200/≥400) was 40% (IQR 70) and 29% (IQR 59), respectively. ConclusionA significant proportion of CRT-D patients presented a high PVC count, however, few received treatment. In the untreated patients with a high PVC count, the PVC burden during follow-up varied substantially. Several consecutive recordings of a high PVC count should be warranted before considering therapeutic action such as catheter ablation.

Approach to Management of Premature Ventricular Contractions.

Premature ventricular contractions (PVCs) are arrhythmias with presentation ranging from asymptomatic and benign to symptomatic, frequent and capable of inducing cardiomyopathy. Work in the late 1970s-1980s showed that they could be representative of underlying coronary artery disease, hypertension, or left ventricular hypertrophy. Furthermore, their presence is independently linked to an increased risk of stroke and sudden cardiac death. Since characterization of PVC-induced cardiomyopathy 21years ago, there has been progressive interest in treating PVCs. This review aims to present an approach that practitioners can use for the treatment of PVCs. Recent efforts have focused on optimizing techniques for mapping and ablation of PVCs in patients with symptoms or reduced LVEF. However, an understanding of the medical treatment options is necessary because medical management is still the first line of therapy. The practitioner will need to weigh the risks and benefits of these strategies in order to help the patient determine the best course of action. PVCs are recognized as a clinically significant arrhythmia, and evolving treatment strategies can improve cardiovascular outcomes. This review provides a concise summary of the current state of PVC treatment.

Acute Efficacy of a Traditional Chinese Medicine for Treatment of Frequent Premature Ventricular Contractions in Patients with Concomitant Sinus Bradycardia: Results from a Double-Blind, Placebo-Controlled, Multicentre, Randomized Clinical Trial.

Pharmacological antiarrhythmic therapy such as beta-blockers in patients with frequent premature ventricular contractions (PVCs) and concomitant bradycardia is challenging. A traditional Chinese medicine, Shensong Yangxin (SSYX), has been effective in treatment of frequent PVCs and sinus bradycardia (SB) in separate patient cohorts. This double-blind, placebo-controlled, multicentre, randomized clinical trial investigates the acute efficacy of SSYX in reducing PVCs burden in patients with concomitant SB. Patients with symptomatic, frequent PVCs, and SB, defined as mean heart rate (MHR) of 45 to 59 beats per min (bpm), were recruited at 33 medical centres in mainland China and randomly assigned by computer to either SSYX or matching placebo for eight weeks. Patients, investigators, and trial personnel were masked to treatment allocation. Primary endpoints were changes in PVCs burden and MHR as assessed by 24-hour Holter monitoring relative to baseline. Secondary efficacy endpoints were subjective symptom score, ECG, and biochemical parameters. Analysis was based on intention-to-treat principles. 333 patients were randomized, of which 166 received SSYX and 167 placebo. Baseline characteristics did not differ. SSYX reduced PVCs burden by 68.2% (p < 0.001) and increased MHR by 10.9% (p < 0.001) compared to 32.2% and 4.7%, respectively, in the placebo group. SSYX group experienced greater symptomatic improvement (p < 0.001). No differences in reported adverse events were seen (20 versus 23). SSYX is an effective antiarrhythmic therapy for symptomatic, frequent PVCs uniquely suited patients with concomitant SB. Clinical trial number was NCT01750775.